Biopsy Report
I finally got my biopsy report today. Can anyone tell me what the following means?
Confirmatory positve cytokeratin and negative e-cadherin immunohistochemistry stains utilized.
Tumor exhibits desmoplastic stroma and a poor lymphoplasmacytice host reponse.
Thanks so much.
Marie
Comments
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Hi Marie, I will share the little bit I know. Cytokeratin stain is used to confirm that a cell is malignant, that is a cancer cell, usually in lymph nodes. When a pathologist is trying to establish that the breast cancer is lobular rather than ductal the e-cadherin stain is sometimes used because, as Sherri said, the vast majority of lobular bc is e-cad negative. When tumor cells create a reaction in the cells outside the breast ducts (the stroma) this is called a desmoplastic stromal reaction. A poor lymphoplasmacytic host response means there was not evidence that the body had a strong immune reaction around the cancer cells, that is there were not a lot of macophages, lymphocytes, plasma cells, etc. Now that I've said all that, there is no evidence, as far as I know, that any of these things have a strong affect on prognosis. These things have been studied for many years, but they are not more useful in determining prognosis or treatment than the simple things used to determine stage like tumor size, number of nodes, nuclear grade, etc.
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Thanks, Sherri and Gitane, The Bloom Richardson Nottingham grades are tubular 3, nuclear 1 and mitotic 1. I was able to find some information regarding the BRN score on the net. The tumor is 100% invasive and it measures at least 12 mm in maximum linear dimension. This report doesn't show the ER, PR and HER2/neu...it was to be sent separately. I will get it from my oncologist hopefully today. Thanks again,
Marie
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Hi Marie
Did you ever think that you would be looking up such things on the internet? I know I didn't. I am starting to think I should go to medical school when this is all over.
My pathology report used the Nottingham system, which is similiar apparently to the Bloom Richardson. Grades on mine were tubular 3, nuclear 2 and mitotic 1. It also indicates confluent tumour necrosis-absent, lymphovascular invasion-absent and perineural invasion-absent. I just thought I would share with you for a comparison sake.
Good luck with your oncologist appointment today. Let us know how it goes.
Take Care
Cathy
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Hi, from what I read in this ILC forum, most of ILC are grade 2 'cause the mitotic is "1", and mitotic is a key (even the most important) to judge how aggressive the tumor is - how fast the cancer cells split...
But I was also told the grading system was designed for IDC and doesn't really work for ILC...
Just want to share with your newbies

BTW, can anybody tell me what "lymphovascular" means? what's the difference between lymphovascular and vascular?
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MW943, All ILC gets a tubule formation score of 3 because lobular doesn't form tubules. Also, many lobular tumors have low mitotic rates (mitotic = 1 like yours) However, if your nuclear grade is 1, that is very good. It indicates that you do not have an aggressive looking cancer under the microscope. It also probably means that you are ER+PR+Her2-, but you won't know that for sure until the pathology comes back. You also have a relatively small tumor (12 mm), compared to others of us who ended up with larger tumors because they weren't detected. Lots of good things.
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Hi, Gitane,
Thanks for sharing, really helps. May I know what "Nuclear"actually means? It's hard to understand but I still want learn
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The education session went as good as it could. Additional biopsy results show PR+ (39%), PR-, HER2/neu-. The breast oncologist was compassionate and patient. She gave a spill about breast cancer is a cruel disease because we can never walk out of a doctor's office and say that we're cured; She says breast cancer patients should always carry two baskets with them every where they go. One with positive thoughts/outcome and one with cautious, potential setbacks. We need to live every day to the fullest and don't waste any time worrying from scan to scan/from dr visit to dr visit. She agrees that a bilateral mastectomy is a good choice due to the nature of ILC. She said the rate of local recurrence for ILC is 1.5% every year (so 15% in 10 years). Due to my family history (Mom survived ovarian cancer in her 50's and died of stomach cancer in her later 70's), she will try to get approval for genetic testing at my request.
I am now awaiting surgery schedule and some other workups in between. Sentinel biopsy will be done during the surgery. Thanks for all the posts and support. Like my breast onco says "hang in there, we will get through this together."
Marie
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Marie,
Have you had any other family members with Lobular breast cancer or stomach cancer (diffuse type) specifically? Do you know what genes they'll be testing you for?
I am CDH1+, I'm told it's rare but it puts one at risk for both lobular breast cancer (40-51% risk) and diffuse gastric cancer (83% lifetime risk for women). My family had earlier onset of the gastric cancers... 30's and 40's.
Anyway, if they do test you for this, or if you want more information I can put you in touch with some really great groups and sites. Good luck to you!
Tanya
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Hi Tanya, she will be testing me for BRCA genes. Other than my mother, I don't have other family members who have had ovarian, gastric or breast cancer. Thanks for your support. I will let you know the outcome.
Marie
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Hi Marie
It sounds like you had a very good meeting with your oncologist. She sounds like she is very compassionate and thorough.
Do you have any idea how long you will have to wait to have your surgery? I have been told mine will likely be beginning of January. I hate having to wait, but at the same time I would like to try to enjoy Christmas with my children. Sounds like you have decided on bilateral? Are you thinking of having reconstruction as well and if so, do you think you will be doing immediate? My doctors seem to be leaning more towards me having the mastectomy and if I want reconstruction, which I think I do, to doing that later. There are so many decision to be made.
Thinking of you
Cathy
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Hey Cathy,
She seemed optimistic that she would get me in before Christmas but as of now, I'm still waiting for the call. I hate to wait so I told her I would appreciate it if she could have me scheduled ASAP. Yes, I'm going for the bilateral. Since I'm so flat chested anyway, hopefully no one will notice.
I won't do the reconstruction until later if ever. My dr says the pain level from a scale of 1-10, the bilateral mastectomy itself is about 3 and with the reconstruction is about 9. She says I don't have enough fat in my stomach to do the flap thingy and the procedure with the expander could be very uncomfortable. I think I will combat one battle at a time. The decisions come easier when you're armed with information. To me, it's a no-brainer with ILC but I think I am older than you (54). I will be thinking of you as well. Please keep me posted.Take care,
Marie
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Hi hyla, per Susan' Love's Breast Book,nuclear grade is another feature indirectly related to tumor growth and differentiation. "The nucleus of the cell is the party that contains the DNA, so the grade gives you an idea of how abnormal the DNA is."
Hope this helps.
Marie
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Thank you Marie!
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